ObamaCare survives, and that's good

ObamaCare survives, for now, and that's good, but it doesn't solve all our problems

How long before we see the first "Impeach John Roberts" bumper sticker?

The chief justice, named to the Supreme Court by Republican President George W. Bush, didn't follow the partisan script, and God bless him for that. Instead, Mr. Roberts joined the court's liberal bloc to uphold the key elements of President Obama's health care reform law despite challenges by 26 states, including Ohio and Michigan.

That's a vital victory, not just for the President but also for millions of other Americans -- in Ohio, Michigan, and everywhere else -- who already are benefiting from the two-year-old Affordable Care Act's provisions.

The high court affirmed the necessary centerpiece of the law, a provision that reasonably requires Americans to obtain health insurance -- just as Ohioans are required to carry auto insurance -- or pay a tax. Do you want to keep subsidizing freeloaders who can afford insurance but refuse to buy it, assuming you'll pay their costly emergency-room bills when they get sick?

The victory isn't assured. Republican presidential nominee Mitt Romney promoted a similar health-care program, including an individual mandate, when he was governor of Massachusetts.

Yet he now vows to repeal ObamaCare -- which is up to Congress, not the president, but never mind -- on "Day One" of his White House occupancy. Republicans in Washington and Columbus, business lobbies, and Tea Party types continue to march in lockstep against the law.

Along with the economy and job creation, the health-care law will be among the critical issues in this year's presidential and congressional campaigns. Mr. Obama will have to defend the most important achievement of his presidency against its army of detractors. Mr. Romney will tell us his better plan for expanding insurance coverage to tens of millions more Americans, while controlling the cost of health care and maintaining its quality -- if he has such a plan, and if he cares.

Opponents of Obama-Care point to last year's 2-to-1 vote by Ohioans to approve a symbolic, deceptively worded constitutional amendment rejecting the individual mandate as evidence of the law's unpopularity here. The reliable Quinnipiac Poll reports that most Ohio voters surveyed last month said they support repeal of ObamaCare.

But if you want some other numbers about the reform law's impact on Ohio, try these:

More than 97,000 young adults in Ohio (and 94,000 in Michigan) have health insurance because of the law's provision that enables Americans under 26 to remain covered by their parents' policy.

So far this year, more than 477,000 Medicare recipients in Ohio (and 524,000 in Michigan) have gotten free preventive services, such as mammograms and colonoscopies, and wellness visits with their doctors -- without deductibles or co-payments -- because of the law. More than 1.2 million Ohioans (and 1.1 million Michiganians) got similar services last year.

More than 2.1 million Ohioans (and more than 1.8 million Michiganians) with limited private health-insurance coverage also have received preventive services without cost-sharing under the law.

Nearly 150,000 Ohioans (and 91,000 Michiganians) who fell through Medicare's dreaded "doughnut hole" have gotten rebates and discounts worth hundreds of dollars to help pay for their prescription drugs. The reform law, if it remains in effect, will eliminate the unfair coverage gap.

These numbers represent real people -- a lot of us. They mean more than empty partisan cliches invoking "freedom" and "socialism" and "government takeover." Let's hear opponents explain to the people the law is helping why these popular benefits must be taken away for their own good.

The high court's ruling also maintains the longer-term promises of Obama-Care: Health insurers can no longer drop customers if they get sick, impose a limit on coverage even for the most catastrophic illnesses, or deny coverage to people with pre-existing conditions.

The law preserves coverage for people who lose or change jobs, invests in cost-effective preventive care, and includes measures to contain growth in health-care costs. The individual mandate includes subsidies for poor and middle-class families and some businesses.

The Supreme Court restricted an ObamaCare provision that threatened to withhold money that states get for their Medicaid health-care programs for poor and disabled recipients, if the states don't expand coverage of uninsured people. Gov. John Kasich warned that the reform law still could explode the state's Medicaid rolls and costs.

That isn't inevitable. But Mr. Kasich and other Columbus Republicans need to stop stalling and finally comply with another central provision of the law: creation by January, 2014, of a state insurance exchange that would promote competition for affordable coverage.

Of course ObamaCare doesn't solve the nation's health-care problems. It still leaves more than 20 million Americans without insurance. The White House and Congress still have much to do to control medical costs.

Patients, providers, and insurers all will have to give up things they want to keep. Democrats and Republicans will have to tell painful truths to key constituencies -- something neither party has shown much ability or willingness to do.

And whether ObamaCare ultimately stays or goes, medical providers will need to adapt the way they do business to evolving market realities, says Andrea Price, president and chief executive of the Mercy health system.

"Regardless of the ruling, health care is going to change," Ms. Price told me. "How we care for patients will change. We need to push for preventive care. The industry has an opportunity to improve, and that's a good thing. Because our mission to serve the community isn't going to change."

Still, we're better off with the law than without it. We're also better off because the ObamaCare ruling wasn't a partisan decision by the Supreme Court, like Citizens United and Bush vs. Gore. But a President Romney would name justices who would be expected to produce more rulings like the latter. Ohio voters should keep that in mind too.

Most important, the ObamaCare ruling ought to help focus voters' deliberations between now and November. It will force us to think hard about what kind of government and nation we want in the next four years and beyond, and encourage us to cast our votes accordingly.

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